HomeMy WebLinkAboutEngwiller, Barbara SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4096 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 487
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner B. ENGWILLER & K MCDONALD
Mailing Address 1 365 SOUND AVE
City St Zip PECONIC NY 11958
Property Address 1
365 SOUND AVE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 2 lot 5.000
Cross Street MILL ROAD
Building Permit Number Cross Reference:
Issue Date: 7/23/12 Elizabeth A. Neville
Southold Town Clerk
, �gUf FO(,�
I�,�o� 00 `
ELIZABETH A.NEVILLE,MMC ��ti. Gy; Town Hall,53095 Main Road
TOWN CLERK p P.O.Box 1179
y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : 'Pt
O Fax Fax(631)765-6145
MARRIAGE OFFICER 'I�
RECORDS OF MANAGEMENT OFFICER ;�,� '�►` l° Telephone(631)765 1800
FREEDOM OF INFORMATION OFFICER - �� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK a 10111,16', n TAO1 _ I
TOWN OF SOUTHOLD ld'a 9a1e
zioz i i incl r'
TO: Southold Town Building Department
1V1
FROM: Carol Hydell, Southold Town Clerk's Office J h [ M Jl
DATED: July 11, 2012
Transmitted herewith is a copy of application No. 4096 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Barbara Engwiller& Kathryn McDonald
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me. Thank you
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
7/2 60/2
Dated
s. , A.NILE i'' 4 Town ice,53095 Main Road
'OWN C 7 P.O.Box 1179
z Southold,New York 11971
REGISTRAR
MAB
MARRIAGE OFFICER
'`, .,, 41„' Fax(631)765.6145
RECO MA1 '' TelePhane(631)165-1800
FREEDOM OP3NPOPMATIONOFFICER ,,,•'F ldLoc n_nortbforknet
OFF=OF THE TOWN CLHRI
• TOWN OF SOU3THOLD
SOUTHOLD WAsrEATATrat DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOLor SEPTIC TANK
Residential Qa $10 or Non-R ®$25 Application No. 4 0
PeitNo.
Applicant Name PECONICL
Applicant Mailing.Address P. Q. BOX 487,
iiikUREL, NEW YORK 11948
Septic Tse•- or Cesspool
Brief Desp:ption of• ", -_: Construction or Allteuilion
1 VIAMA/{\ _ cx_sl,g,0X., ..
Location of Proposed Co.,_ •'R Ammon: f ivicosila,t0(
Owner of •C 1 OL � - -Ka �Y� vl
OwnearMa mgAdd ess: n 91, oc.A9 C
Cofl/tc
Owner Property Address:,,-) 3C5 SO i 01 C
19sNaaccohie N 1195--
Name
me and phone number of contact person 5 lQQ - "Z,
Tax Map No: Section Vr7 . B,• fQ Lot J-
Cross Street M 6'I
NOTE: LOCATION MAP MUST BE a s :i.1 ton .WITH APPLICATION. NEW
CONSTRUCTION i MIMS SUR WITH _ = �t`H DEP TMENTPVAI,
GulttAA-A ' 7797tc .
: .:1i^eg- .. " , • ' >-_; e
ii
/gl ) ,I/ rif
Received by: - f
tNi
so,145v1j out)e, 15
I I p
i1 f
- f /-,-- i
1 SG D
I �
\ I